Therapy of Fibrinous Membranes in the Anterior Chamber With Intracameral Tissue Plasminogen Activator After Cataract Surgery
Purpose
To evaluate the efficacy and complications of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous membrane after uneventful cataract surgery
Methods
In this retrospective study 14 eyes of 14 patients after uncomplicated cataract surgery were considered between March 2013-May 2014. Despite intensive topical-subconjunctival corticosteroid therapy, there were severe fibrinous anterior chamber reactions in the early postoperative period. Because of this, 25 µg of r-tPA was applied intracamerally. Patients were evaluated for complete fibrinolysis, recurrence of fibrious membrane or complications by slitlamp biomicroscopy 2, 12 and 24 hours, 2 and 7 days, 1 and 6 months after r-tPA application. In addition intraocular pressure (IOP) was measured by Goldmann applanation tonometry. Visual acuity was evaluated using a standard Snellen chart 1 week after r-tPA application.Mean age was 69±0.71 and male-female ratio was 6/8.Four of patients with fibrinous reaction had diabetes mellitus (DM), 3 of cases had glaucoma,1 had uveitis history.
Results
3 patients had pupillary block glaucoma due to fibrinous membrane.After topical and systemic anti-glaucoma treatment, peripheral iridotomy and membranotomy with Nd: YAG laser, IOP decreased to normal levels but the fibrin membrane was not resolved. Various degrees of posterior synechiae were noted in the other 11 patients. After injection of r-tPA,fibrinous membrane was completely dissolved and posterior synechiae were fully opened in 2-24 hours in all patients. In 2 patients with DM and in the patient with uveitis, a second injection was required as a result of recurrent fibrinous membrane. The day after the injection, fibrinous membrane was completely resolved. 6 eyes had transient corneal edema. Visual acuity improved by 2 to 6 lines in all patients. No patient had an increase in IOP , hyphema or recurrence.
Conclusion
Intracameral recombinant tissue plasminogen activator is a safe and effective therapy in eyes with anterior chamber fibrinous membranes, which do not respond to intensive corticosteroid therapy.